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Is health care a right or a responsibility? During the third presidential debate, Barack Obama declared it to be a right, while John McCain called it a responsibility.
These assertions underscore the different philosophies underlying the candidates' proposals. One assumes that everyone is entitled to health care; the other puts the responsibility for obtaining health care squarely on the shoulders of the consumer.
Consumers already have plenty of responsibilities, such as the responsibility to find a way to retire even if the stock market trashes their retirement plans, for which they have complete responsibility.
In all fairness, the Republican candidate does propose changes to the health care system that are designed to expand its availability and enhance consumer choice. In fact, both candidates propose strategies designed to control costs while improving quality, such as promoting prevention and chronic care management, and investing in health information technology systems that produce electronic health records. In these ways, their plans are similar.
But in other ways, their plans offer
starkly different solutions to the problem of
more than 45 million uninsured Americans.
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| Anatomy of a new health plan |
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1. The Obama plan
Obama's campaign site discusses his health care plan in much more detail, but below are the central points.
- All Americans could choose to keep health coverage with their current employer (if they have one) or opt for a new affordable plan through the National Health Insurance Exchange. That new entity would consist of a public health care plan like the one offered to members of Congress, as well as approved private plans with comparable coverage. Tax credits to help individuals pay for premium costs would be available on a sliding scale to needy families.
- All Americans, regardless of their past or
current health status, would be eligible for
affordable health care coverage because insurance
companies would be compelled to accept all citizens
regardless of pre-existing conditions. Premiums
would be stable and not depend on health status.
- Benefits would be comprehensive, affordable and portable.
- Small businesses would receive a refundable tax credit of up to 50 percent for premiums they pay on behalf of all their employees, as long as they offer a quality plan and pay for a meaningful part of the cost.
- Large employers that do not offer quality health coverage or that do not pay a significant amount toward its cost would have to contribute a percentage of payroll toward the cost of the national plan. This does not apply to small businesses.
- Children would have mandatory coverage, and young adults up to age 25 would have coverage through their parents' plans. Eligibility for Medicaid and SCHIP (State Children's Health Insurance Program) also would be expanded.
- States could continue to offer health care coverage, as long as they meet the minimum standards of the national plan.
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